The combination of poor diet and sedentary lifestyles is second only to smoking in causing preventable health problems and deaths in the United States[a].¹ The consequences go well beyond health, impacting quality of life, productivity, and the general economy. These effects can be avoided through more active lifestyles, combined with good eating habits.

Until this survey was conducted, only a little more than anecdotal information was known about eating and physical activity habits within Marion County. There were many outcomes indicating unhealthy habits, including: high rates of diabetes and other chronic diseases; high state-level rates of obesity and obesity-related Medicaid expenditures[b]; and county-wide obesity rate estimates that exceed the rest of Indiana. However, these estimates were based on too few people to adequately assess which groups in Marion County have the greatest problems. There was also little information about the habits, attitudes, and factors contributing to obesity among our 870,000 residents.

A generous grant from the Richard M. Fairbanks Foundation made it possible for the Marion County Health Department (MCHD) to conduct the first comprehensive adult obesity needs assessment telephone survey. Between February and June, 2005, telephone interviews of 4,784 adults in Marion County were conducted to establish information about body mass index (BMI), physical activity behaviors, food intake, eating patterns, and other related factors. The result is a very rich data set, sufficient to assess physical activity, nutritional status, obesity, in many population subgroups, as well as for the county as a whole. Highlights from the analyses are included in this report.

General Results

Survey results indicate that one-quarter of Marion County adults were obese (25.6%), and 60 percent were either overweight or obese. Obesity was common in all demographic groups, especially among Black females, the middle-aged, persons with lower incomes, and those with chronic health problems.

Eating habits were poor, though there are indications that many people would like to improve their dietary habits. Few Marion County adults, particularly obese adults, ate as many fruits and vegetables as are recommended, and most people did not pay attention to the serving size on food labels. However, most people paid at least some attention to nutrition labels, and looked for nutrition information at restaurants. Among those who did not practice healthful eating, most intended to improve their eating.

While most of the population was at least somewhat physically active, a large portion was not. Most relatively inactive people would like to increase their activity levels. Many people were physically active in their jobs, and most people had safe, convenient, affordable places to exercise. Between one-third and one-half of adults walked for exercise at least a few times per week. But four out-of-ten obese adults and three out-of-ten other adults did not achieve the United State’s Centers for Disease Control and Prevention (CDC) recommended level of physical activity. Almost half of those adults intended to increase their level of activity within 30 days.

Poverty was clearly related to nutrition and physical activity barriers. Three out-of-ten adults with low incomes had poor access to fruits and vegetables. Four out-of-ten reported that they had no safe, affordable, convenient place to exercise.

Body Weight

In Marion County, one out-of- four adults (25.6%) who responded to the survey was obese. Six out-of-ten adults were overweight or obese (60.7%). These percentages are similar to state and national statistics. The data were analyzed by race, gender, age, income, education, and area of residence within the county. The greatest differences in BMI[c] occurred in the race by gender analysis, with Black females having notably higher rates of obesity than any other demographic group.

· Females, by race: Eight out-of-twenty (39%) Black females were obese, and over two-thirds (69%) were obese or overweight. In comparison, less than five out-of-twenty (23%) White or Latino females were obese, and ten out-of-twenty (49% and 50%, respectively) were obese or overweight

· Males, by race: There was less difference in obesity by race among males. Black males had a few percentage points more obesity (28%) than White (24%) or Latino men (19%) (Figure 5).

· Age: The youngest adults (less than 25 years of age) and oldest (over 75-years-old) had the least obesity (16%), while middle-aged persons (45 to 64 years old) had the most (31%) (Figure 6).

· Education: Level of education had a moderate influence, with college graduates having about seven percentage points less obesity than those with less education (21% versus about 28%).

· Income: The prevalence of obesity also declined as income increased, from 34 percent for the lowest income adults to 23 percent for adults with higher income.

· Geographic area: Obesity prevalence also varied by area within the county, with prevalence in the low 30-percent range occurring in a band that ran roughly east-west across the county, just north of the middle of the county. Most other areas had prevalence in the mid to-low-20 percent range.

· Weight change: Females were more likely than males to consider themselves overweight, even among those in the Normal or Underweight BMI category. Half of overweight males and one out-of-seven obese males considered themselves at “about the right weight”. About one third of overweight and obese males and females had tried to lose weight in the prior year.

· Health effects: Increased weight was clearly associated with increased chronic disease. Chronic disease was almost twice as common among those in the Obese BMI category compared to those in the Normal or Underweight BMI category.

· Advice from clinicians: One-third of obese adults and two-thirds of overweight adults reported that a doctor had not told them that they were overweight. Many obese adults (over 40%) and most adults who are not obese (50% to 75%) had not received nutrition or physical activity advice from their doctors.

Diet and Nutrition

· Healthy eating: Most adults reported eating fewer fruits and vegetables than are recommended by the CDC, and more red meat than many nutrition experts advise. Overweight, and especially obese adults ate more red meat and fewer fruits and vegetables than did adults in the Normal or Underweight BMI category. Three out-of-four adults ate less fruit than is recommended, and only one-in-twenty adults ate as many vegetables as are recommended. However, most obese adults were planning to change their eating habits to eat a more healthy diet.

· Nutrition labels and serving size: While two-thirds of adults read nutrition labels at least some of the time when buying groceries (Figure 20), only half of adults looked at the serving size on the label at least some of the time in deciding how much to eat (Figure 21). About half also looked for nutrition information at restaurants, at least some of the time.

· Access to fruits and vegetables: Most adults had convenient access to a store selling fresh fruits and vegetables, though 15 percent of adults with incomes below the poverty level[d] did not. The produce at these stores was affordable for most people, though it was not affordable for the 10 percent of adults whose household income was in the lower third of Marion County household incomes.[e] Combining these factors, 13 percent of Marion County adults, including 31 percent of adults living in poverty, did not have convenient access to affordable fruits and vegetables.

Physical Activity

· Amount of physical activity: As might be expected, adults with lower BMI values were more physically active and more frequently met the CDC’s minimum recommended activity level. The percent that met the CDC’s minimum recommended level of physical activity tended to decrease with age. Except among adults less than age 25, obese adults met recommended physical activity levels comparable to non-obese adults who were twenty to thirty years older.

· Readiness to change: Almost half of those who did not meet the CDC’s minimum recommended activity level indicated that they intended to increase their physical activity level in the next 30 days. Adults in the Obese BMI category were most likely to report that they intend to increase their physical activity, but they were less likely to have maintained an increase for longer than six months.

· Physical activity at work: Employment offered many people opportunities to be physically active. Three out-of-five employed adults had jobs that kept them physically active. About 30 percent of adults in each BMI category had access to a place to exercise at work, and a similar proportion had employer incentives to exercise.

· Physical activity in the community: Eight-of-ten respondents reported having a safe, convenient and affordable place to exercise in their communities. No two race and gender groups differed by more than ten percent in their access to such places. Access declined however as household income decreased, especially for those in the Overweight and Obese BMI categories. Less than 60 percent of overweight and obese adults in households with incomes below the federal poverty level had safe, convenient and affordable places to exercise.

· Safety concerns about exercising in their community: Among adults reporting no safe, convenient and affordable place to exercise, only one-in-twenty) had safety concerns about exercising in their community. Convenience and/or affordability may have been barriers for the other 19. As with other barriers, the safety barrier was greatest for obese and overweight adults with very low income, who were two-to-six times more likely to have safety concerns as any other group.

· Walking in neighborhood: Between one-third and one-half of adults walked at least weekly in their neighborhood for exercise. Those in the higher BMI categories were least likely to walk in their neighborhoods. Respondents with household incomes below the federal poverty level were most likely to walk in their neighborhood every day. This may reflect a lack of personal transportation for this lowest income group. Among race and gender groups, Black females were the most likely to never walk in their neighborhood for exercise (36%), while Black males were most likely to walk daily in their neighborhood for exercise (27%).

Introduction

Figure 1: Adult Obesity Prevalence in Indiana and the United States, 1990-2005

Source: CDC BRFSS http://www.cdc.gov/brfss/

In 1990, about one eighth (11.6%) of adults in the United States were obese. In 2005, about one-quarter of adults was obese. The prevalence of obesity had doubled in just 15 years. Obesity in Indiana has consistently been more common than in the rest of the country, by about three percentage points.

Obesity and Health

The combined effect of poor diet, lack of physical activity, and excessive body fat is second only to tobacco in causing premature death in the United States.